Case report
DOI: 10.5114/kitp.2015.54462
Novel variant of dual left anterior descending artery arising from single right coronary artery anomaly presenting with angina inversa Faruk Cingoz1, Gokhan Arslan1, Atilla Iyisoy2, Hakan Bingol3 1Department
of Cardiovascular Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey of Cardiology, Gulhane Military Medical Academy, Etlik, Ankara, Turkey 3Department of Cardiovascular Surgery, Baskent University, Konya, Turkey 2Department
Kardiochirurgia i Torakochirurgia Polska 2015; 12 (3): 246-247
Abstract
Streszczenie
A 55-year-old female without a history of coronary artery disease, hypertensive for the past 17 years, was admitted with resting chest pain. Electrocardiography revealed a negative T-wave in anterior chest leads. Coronary angiography visualised anomalous coronary anatomy, with a common origin of the right coronary artery and the left main coronary artery in the right sinus of Valsalva serving as a common coronary trunk. It should be emphasised that T-wave abnormalities and chest angina may be related to this congenital coronary anomaly. Key words: coronary anomaly, ischaemic heart disease.
W pracy opisano przypadek kobiety, lat 55, bez choroby wieńcowej w wywiadzie, chorującej na nadciśnienie od 17 lat, która została przyjęta ze spoczynkowym bólem klatki piersiowej. Badanie elektrokardiograficzne wykazało ujemny załamek T w odprowadzeniach przedsercowych. Angiografia naczyń wieńcowych uwidoczniła nietypową anatomię naczyniową w postaci wspólnego odejścia prawej i lewej tętnicy wieńcowej od zatoki Valsalvy stanowiącej wspólny pień wieńcowy. Warto zwrócić uwagę, że nieprawidłowości załamka T i bóle klatki piersiowej mogą wynikać z tej wrodzonej anomalii wieńcowej. Słowa kluczowe: anomalia wieńcowa, choroba niedokrwienna serca.
Case report
nary trunk (single coronary artery) (Fig. 3). Circumflex and left anterior descending arteries were arising from the left main stem. Right coronary artery was normal. Meanwhile, a second left anterior descending artery was seen arising from the proximal right coronary artery (Fig. 3 and 4). This was consistent with the novel variant of dual left anterior descending artery maybe subgroup of type IV according to Spinaldo-Franco Classification [1]. It emphasises that T wave abnormalities and chest angina may be related this congenital coronary anomaly.
A 55-year-old female without a history of coronary artery disease, hypertensive for 17 years duration was admitted with chest pain at rest. Her electrocardiography revealed negative T-wave in anterior chest leads (Fig. 1), and T waves were returned to normal fashion without medical treatment within 10 minutes (Fig. 2). Echocardiogram showed normal left ventricle systolic function and ejection fraction (> 60%). Her biochemical parameters were within normal limits and her stress test was normal as well. She was subjected to coronary angiography to rule out any ischaemic aetiology. At coronary angiography, there was no obstructive coronary artery disease; however, the coronary angiogram demonstrated an anomalous coronary anatomy, with the origin of the right coronary artery and left main stem from the right sinus of Valsalva as a common coro-
Reference 1. Spinaldo-Franco H, Grose R, Solomon N. Dual left anterior descending artery: angiographic description of important variants and surgical implications. Am Heart J 1983; 105: 445-448.
Address for correspondence: Faruk Cingoz, MD, Gülhane Askeri Tıp Akademisi, Gn. Dr. Tevfik Sağlam Cad., 06010 Etlik, Ankara, Turkey, phone: +90 312 3045220, fax: +90 312 3045200, e-mail: [email protected]
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Kardiochirurgia i Torakochirurgia Polska 2015; 12 (3)
Case report
Fig. 1. 12-lead electrocardiogram showing negative T waves in anterior chest leads during chest pain at rest
Fig. 2. 12-lead electrocardiogram showing normal T-waves in anterior chest leads after chest pain
Fig. 3. Single coronary artery and double LAD arteries. Coronary angiography in a caudal right anterior oblique view shows all coronary arteries arising from right sinus of Valsalva with a common trunk. LAD2 (arrows) arises from the RCA (arrow) and then turns sharply down the anterior interventricular sulcus. LAD (arrow) forms a short vessel, which produces both septal perforators and diagonal branches.
Fig. 4. Multidetector computed tomography, 3-dimensional volume-rendered reconstructed image of the coronary system. LAD2 (arrow) arises from the right coronary artery (arrow) and then turns sharply down the anterior interventricular sulcus and extends to the apex of the heart. Left anterior descending artery (arrow) forms a short vessel RCA – right coronary artery, LAD – left anterior descending artery
LMCA – left main coronary artery, Cx – circumflex artery, LAD – left anterior descending artery, RCA – right coronary artery
Kardiochirurgia i Torakochirurgia Polska 2015; 12 (3)
247
DOI: 10.5114/kitp.2015.54462
Novel variant of dual left anterior descending artery arising from single right coronary artery anomaly presenting with angina inversa Faruk Cingoz1, Gokhan Arslan1, Atilla Iyisoy2, Hakan Bingol3 1Department
of Cardiovascular Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey of Cardiology, Gulhane Military Medical Academy, Etlik, Ankara, Turkey 3Department of Cardiovascular Surgery, Baskent University, Konya, Turkey 2Department
Kardiochirurgia i Torakochirurgia Polska 2015; 12 (3): 246-247
Abstract
Streszczenie
A 55-year-old female without a history of coronary artery disease, hypertensive for the past 17 years, was admitted with resting chest pain. Electrocardiography revealed a negative T-wave in anterior chest leads. Coronary angiography visualised anomalous coronary anatomy, with a common origin of the right coronary artery and the left main coronary artery in the right sinus of Valsalva serving as a common coronary trunk. It should be emphasised that T-wave abnormalities and chest angina may be related to this congenital coronary anomaly. Key words: coronary anomaly, ischaemic heart disease.
W pracy opisano przypadek kobiety, lat 55, bez choroby wieńcowej w wywiadzie, chorującej na nadciśnienie od 17 lat, która została przyjęta ze spoczynkowym bólem klatki piersiowej. Badanie elektrokardiograficzne wykazało ujemny załamek T w odprowadzeniach przedsercowych. Angiografia naczyń wieńcowych uwidoczniła nietypową anatomię naczyniową w postaci wspólnego odejścia prawej i lewej tętnicy wieńcowej od zatoki Valsalvy stanowiącej wspólny pień wieńcowy. Warto zwrócić uwagę, że nieprawidłowości załamka T i bóle klatki piersiowej mogą wynikać z tej wrodzonej anomalii wieńcowej. Słowa kluczowe: anomalia wieńcowa, choroba niedokrwienna serca.
Case report
nary trunk (single coronary artery) (Fig. 3). Circumflex and left anterior descending arteries were arising from the left main stem. Right coronary artery was normal. Meanwhile, a second left anterior descending artery was seen arising from the proximal right coronary artery (Fig. 3 and 4). This was consistent with the novel variant of dual left anterior descending artery maybe subgroup of type IV according to Spinaldo-Franco Classification [1]. It emphasises that T wave abnormalities and chest angina may be related this congenital coronary anomaly.
A 55-year-old female without a history of coronary artery disease, hypertensive for 17 years duration was admitted with chest pain at rest. Her electrocardiography revealed negative T-wave in anterior chest leads (Fig. 1), and T waves were returned to normal fashion without medical treatment within 10 minutes (Fig. 2). Echocardiogram showed normal left ventricle systolic function and ejection fraction (> 60%). Her biochemical parameters were within normal limits and her stress test was normal as well. She was subjected to coronary angiography to rule out any ischaemic aetiology. At coronary angiography, there was no obstructive coronary artery disease; however, the coronary angiogram demonstrated an anomalous coronary anatomy, with the origin of the right coronary artery and left main stem from the right sinus of Valsalva as a common coro-
Reference 1. Spinaldo-Franco H, Grose R, Solomon N. Dual left anterior descending artery: angiographic description of important variants and surgical implications. Am Heart J 1983; 105: 445-448.
Address for correspondence: Faruk Cingoz, MD, Gülhane Askeri Tıp Akademisi, Gn. Dr. Tevfik Sağlam Cad., 06010 Etlik, Ankara, Turkey, phone: +90 312 3045220, fax: +90 312 3045200, e-mail: [email protected]
246
Kardiochirurgia i Torakochirurgia Polska 2015; 12 (3)
Case report
Fig. 1. 12-lead electrocardiogram showing negative T waves in anterior chest leads during chest pain at rest
Fig. 2. 12-lead electrocardiogram showing normal T-waves in anterior chest leads after chest pain
Fig. 3. Single coronary artery and double LAD arteries. Coronary angiography in a caudal right anterior oblique view shows all coronary arteries arising from right sinus of Valsalva with a common trunk. LAD2 (arrows) arises from the RCA (arrow) and then turns sharply down the anterior interventricular sulcus. LAD (arrow) forms a short vessel, which produces both septal perforators and diagonal branches.
Fig. 4. Multidetector computed tomography, 3-dimensional volume-rendered reconstructed image of the coronary system. LAD2 (arrow) arises from the right coronary artery (arrow) and then turns sharply down the anterior interventricular sulcus and extends to the apex of the heart. Left anterior descending artery (arrow) forms a short vessel RCA – right coronary artery, LAD – left anterior descending artery
LMCA – left main coronary artery, Cx – circumflex artery, LAD – left anterior descending artery, RCA – right coronary artery
Kardiochirurgia i Torakochirurgia Polska 2015; 12 (3)
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